CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Promedica Monroe Regional Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $108
Cash Discount Price: $100
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Promedica Monroe Regional Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.13x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $100 (105%)

Insurance Median: $108 (113%)

Cash: $100 (105% of Medicare)

Ins. Median: $108 (113% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Priority Health	$62 - $117	65%
Amerihealth	$63	66%
Paramount Healthcare Inc	$72 - $117	76%
Blue Cross Blue Shield	$86 - $196	90%
Frontpath	$89	93%
Aetna	$90 - $108	95%
Health Alliance Plan	$90 - $126	95%
Humana	$93	98%
Encore Health Network	$108	113%
Health Ohio Network, Llc	$108	113%
Cofinity	$110	116%
UnitedHealthcare	$125	131%
Multiplan	$139	146%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $100.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Promedica Monroe Regional Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.